Practicing in Resource-Poor settings

At City on a Hill's monthly free clinic, one gets to practice medicine a little differently than at my usual place of work. For one thing, we do not have access to the same resources (labs, imaging, sub-specialties) that one has in a larger clinic, multi-specialty venue or hospital. And yet, patients may have problems that could benefit from this. I saw a woman with an obvious goiter. Interestingly, her mother had the same thing. They had lived their entire lives in the U.S. in a city. She had mixed symptoms of both hyper and hypothyroidism. Management is proving to be challenging. I chatted with an endocrinologist friend who is from India. He suggested some physical exam techniques and history I could obtain to help manage her without further expensive imaging. I benefited from his experience managing patients in a resource-poor setting.